Previous work had tied job worries to heart disease, too

Action Points

High levels of job insecurity were associated with a 19% increased risk in developing diabetes.

Note that in a prior meta-analysis, job insecurity was associated with a 19% increased risk of myocardial infarction or coronary death.

High levels of job insecurity were associated with a 19% increased risk in developing diabetes, according to a recent meta-analysis published this week in CMAJ.

In the study, Jane E. Ferrie, PhD, of the University of Bristol and colleagues analyzed 19 studies from the U.S., Europe, and Australia to assess the relationship between self-reported job insecurity and the level of risk for new diabetes cases.

Previous studies have reported an association between job insecurity and increased risk for dyslipidemia, coronary heart disease, and diabetes complications.

In an interview with MedPage Today, Ferrie discussed her past research, which was the basis for the current study. "We did some work on job insecurity generated by the privatization of the public sector in the 1990s, and that work showed that job insecurity was associated with risk factors for heart disease, like an increase of harmful lipids and weight gain," she explained.

"Once the original study had enough follow-up time, pooling the data with those from other studies gave us sufficient power to look at the association between job insecurity and new-onset coronary events. This meta-analysis showed job insecurity to be associated with a 19% increased risk of myocardial infarction or coronary death. Since diabetes is a risk factor for coronary heart disease, we felt it important to see if job insecurity was also associated with an increased risk of new-onset diabetes. No one had examined this question previously."

Among the 19 cohort studies examined, eight were open-access and 11 were taken from European cohort studies. Data were assessed on a total of 140,825 participants, all of whom were diabetes-free at baseline. During the average follow-up of 9.4 years (range of 4.0-21.1 years), there were 3,954 new cases of diabetes among the participants.

Job insecurity was self-reported through scaled questionnaires administered at baseline, inquiring on the individual's level of insecurity or satisfaction with current job, or level of fear over a layoff or unemployment. For diabetes diagnosis, studies reviewed in the meta-analysis utilized either the World Health Organization criteria or the International Statistical Classification of Diseases and Related Health Problems 10th Revision code E11.

The researchers used a risk estimate to evaluate the relationship between job insecurity and risk of diabetes after computing individual estimates from each of the studies included.

Reportedly high levels of insecurity with a job were linked to a moderately increased risk of developing diabetes (adjusted odds ratio for age and sex, 1.19, 95% CI, 1.09-1.30). After adjusting for all aforementioned variables, the results were similar (adjusted OR 1.12; 1.01-1.24). When the authors restricted the multivariable analysis to only high-quality studies, the results were also comparable (pooled OR 1.19, 1.01-1.35).

"This new work suggests that people who feel their job to be insecure have a modest increased risk of developing diabetes," Ferrie said. "Because of the association with coronary events described above and indicative evidence from our own previous study, we were not surprised by the results."

In addition to coronary event risk, the authors also discussed how the current findings were supported by their past research on the association between job insecurity and weight gain, which is a known risk factor for diabetes.

Job insecurity poses a valid public health threat and should be treated accordingly, Ferrie said. "Ideally these findings should be interpreted in a public health context, which would mean, in this case, that measures were taken to reduce the number of jobs that are insecure. Sadly, at present the increasing preference of employers for zero-hours contracts is moving things in the opposite direction. At the level of the individual, both workers and healthcare professionals should be aware that people exposed to job insecurity may be at a modest increased risk of diabetes, so any symptoms of diabetes should be taken seriously."

While the study examined a large, comprehensive sample group spanning several countries, data on job insecurity were collected typically through one question and differed throughout the various studies, she noted, adding that the results of the meta-analysis should be "replicated in other populations and settings to ensure that they are not context-dependent."

The IPD-Work Consortium is supported by NordForsk, the Nordic Programme on Health and Welfare; the EU New OSH ERA Research Programme; the Academy of Finland; and the Bupa UK Foundation. The senior author, Mika Kivimäki, was supported by the Medical Research Council and the Economic and Social Research Council, UK.

The authors disclosed no other relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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